Wednesday, December 26, 2007

Health care: stay north to stay well

In the layoff season, a middle-aged person's fancy lightly turns to issues of health care. A good place to catch up on what looks to me like reality-based information is the Commonwealth Fund's ten top story list. Two caught my eye:

"4. ...A Commonwealth Fund survey of primary care physicians and patients in five other nations—Australia, Canada, Germany, New Zealand, and the United Kingdom—finds that the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. ...While no one country provided a perfect model of care, there are many lessons to be learned from the strategies at work abroad."

Even more interesting, unless you're already headed for Canada or South Korea:

"7. A state scorecard finds wide variations in health care exist across states.The Commonwealth Fund's first state scorecard found that health care quality, cost, and access vary widely across states, suggesting that where you live can make a big difference to your health."

In this ranking, Iowa was #2, Wisconsin #9, Michigan #16. (There are lots of details.) Moving down a tier, Missouri #37, Illinois #36, Indiana #38. Moving down one more tier: Arkansas #48, Kentucky #45.As far as this part of the Midwest goes, you're likely to get better health care the farther away you can get from areas settled by people from the South. Taking the "hospital" out of "hospitality," I guess.

3 comments:

Oh c'mon now, that "study" has logic holes big enough to drive an ambulance through. The most important being that its lede is not actually a study of any outcomes but rather simply a _survey_ of what doctors think offhand, which "confirms" a similar _survey_ of what patients think. Big news flash: people who are sick and dealing with doctors and hospitals think the process should work better, who'd a thunk it!

(What human beings collectively _think_ to be true about a complex subject is sometimes interesting and occasionally even important, but it is never not ever evidence of what is _actually_ true. For example surveys of both crime victims and police officers still routinely "report" that violent crime has risen in this country, which in fact is wildly incorrect.)

Notice also that when the Commonwealth Fund does talk about actual health-care _outcomes_, they shift the framing: rather than the U.S. health care system doing actually worse than the others, it shifts to "fails to achieve BETTER health outcomes than the other countries" (emphasis added here). Which is an argument one can make, sure, but it is a very _different_ argument than the one you reported and that they clearly want people to take away.

And as always when comparing data on outcomes, that study completely fails to attempt any adjusting for context: the other nations to which the U.S. is compared are far more like each other demographically than any of them is like the U.S. None have anywhere near as high a proportion of new immigrants as the U.S., nor of racial/ethnic diversity, etc. Simply comparing the health-care outcomes of the U.S as a whole to those of New Zealand or Canada, straight-up, is patently silly and tells us nothing of interest about either country's health-care system.

On the health care system we basically don't, unfortunately. The signal-to-noise ratio on that particular topic is off the charts these days, rather reminds me of environmental issues or violent crime a couple decades ago (remember "the coming wave of teenage superpredators"?). Not that brainless old memes don't still get propagated -- that will never completely stop so long as the Ralph Nadar generation is still alive and getting airtime -- but there does seem to be a necessary cycle to the collective conversation and on health care we're still in the smug-hysteria-peak part of the curve.

Hence I don't myself have a broad theory about health care, starting even with the question of to what degree it is actually a major problem needing specific solving. It's just one of those big subjects, like urban sprawl which you have written about, about which right now 98% of what most people hear and say and think they know doesn't hold up to 60 seconds' thought.